Gender: A Wider Lens
Gender: A Wider Lens
111 — Affirmation Therapy: Necessary, But Not Sufficient

111 — Affirmation Therapy: Necessary, But Not Sufficient


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Until recently in many parts of Europe, and currently in the United States and Canada, the affirmative model of care is the primary practice in place for working with gender-nonconforming and gender-diverse youth and children. In this episode, Stella and Sasha put some intention into a deeper exploration of what affirmation therapy is exactly. They take time flushing out not just what it is but also facilitate consideration of what it means and what it achieves. Together they reflect on where the concept of affirming therapy came from, how it evolved into its current practice, when a clinician follows the affirmation model, how does that look in practice, and what are the implications?

Sasha and Stella also explore varying types of therapy, both similar to and in contrast to the fundamental premise of the affirmative approach, what they think about it, and does it actually offer any context for a comprehensive therapeutic process in the name of care?


Gender: A Wider Lens (YouTube Channel)

Live Stream Event from the Genspect Conference: The Bigger Picture

Friday, April 28, 2023 at 11am(PT) / 2pm(ET) / 7pm(IT)

*NEW* Sponsor – GETA

Gender Exploratory Therapy Association

GETA Workshop: Gender Trouble, Authoritarianism, and the Flight from Womanhood

Saturday, April 22, 2023 — 6 pm‒7:30 pm(ET)

Sasha’s YouTube

Genspect Conference: The Bigger Picture

Stella’s Book: What Your Teen is Trying to Tell You

Stella on Benjamin Boyce w/ Eliza Mondegreen

The Dangerous Radicalization of Gender Rhetoric | with Stella O’Malley & Eliza Mondegreen

Critical Therapy Antidote (CTA) book, Sasha & Stella contributing authors

Cynical Therapies: Perspectives on the Antitherapeutic Nature of Critical Social Justice

Carl Rogers: Founder Of The Humanistic Approach To Psychology 

APA Guidelines for Psychological Practice With Transgender and Gender Nonconforming People

Embracing a Gender-Affirmative Model for Transgender Youth: A growing number of individuals disclosing their transgender identities underscores the need for competent care for this population

LGBT Affirmative Therapy: Tips for creating a more lesbian, gay, bisexual, transgender, & queer inclusive practice from the AAMFT Queer Affirmative Caucus

If you liked this episode, more episodes you might find interesting:

“Conversations about Medical Interventions & Gender”

“Top Episodes for Therapists Working with Gender-Questioning” 

“GIDS at the Tavistock”

“The Dutch Studies” 

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Sasha Ayad:

Stella O’Malley:

Extended Notes:

  • The live stream in Killarney includes conversations about the mental, psychological, and sociological aspects of gender.

  • Sasha and Stella are working on the final edits of their upcoming book.

  • Sasha is updating her YouTube channel to include new content.

  • Sasha and Stella discuss the affirmation model and offer their opinions about the process.

  • Stella highlights the differences between the therapeutic process and therapeutic support.

  • Common underlying assumptions of therapists in the affirmative model.

  • How many therapists have a transphobic bias?

  • Sasha discusses the topics that can make therapists uncomfortable.

  • The resurgence of the positivity culture of the ’90s in therapy.

  • Combining positive thinking, social justice, and advocacy piece was a perfect recipe for the affirmative therapy model.

  • How does the affirmative model affect clinicians who don’t 100% believe in it?

  • The culture of the affirmative model is totalizing.


“Affirming a person in the context of therapy is actually quite boilerplate.” — Sasha [17:42]

“There is a difference between therapeutic process and therapeutic support.” — Stella [29:00]

“This positive, affirming thought process was in counseling. We were very ripe for the picking.” — Stella [55:10]

“The philosophy of affirmative therapy, especially as it begins to incorporate a social justice perspective by definition, is totalizing. It reminds me of high-control groups.” — Sasha [1:00:49]

Gender: A Wider Lens
Gender: A Wider Lens
Therapists Stella O’Malley and Sasha Ayad explore diverse perspectives through a psychological lens, fostering open dialogue on gender identity, transition, and the transgender umbrella. Their work with gender dysphoric clients and unique experiences yield an informed outlook delving into gender's psychological nuances. Interviews with clinicians, academics, transgender individuals, parents, detransitioners, and others touched by gender provide varied insights and intimate inquiry into the taboo yet relevant topic.